Enhancing emergency care in low-income countries using mobile technology-based training tools

Edgcombe, Hilary; Paton, Chris; English, Mike

doi:10.1136/archdischild-2016-310875

Cited by 22 publications

(27 citation statements)

References 31 publications

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“…Mobile phones are increasingly being used to support healthcare training in low-and middle-income countries (LMICs), driven by demand for more accessible and scalable training opportunities (Edgcombe, Paton, and English 2016). In Sub-Saharan Africa, the proliferation of mobile phones has generated keen interest to implement mobile learning in a range of sectors.…”

Section: Introductionmentioning

confidence: 99%

Can mobile health training meet the challenge of ‘measuring better’?

Winters

Oliver

Langer

2016

Comparative Education

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Mobile learning has seen a large uptake in use in low-and middleincome countries. This is driven by rhetorics of easy scaling, reaching the hard-to-reach and the potential for generating analytics from the applications used by learners. Healthcare training has seen a proliferation of apps aimed at improving accountability through tracking and measuring workplace learning. A view of the mobile phone as an agent of change is thus linked with a technocentric approach to measurement. Metrics, initially created as proxies for what gets done by health workers, are now shaping the practices they were intended to describe. In this paper, we show how, despite some valiant efforts, 'measuring better' remains difficult to achieve due to entrenched views of what measurement consists of. We analyse a mobile health (mHealth) classification framework, drawing out some implications of how it has been used in training health workers. These lead us to recommend moving away from a view of mobile learning linked tightly to accountability and numbers. We suggest a focus on an alternative future, where 'measuring better' is promoted as part of sociocultural views of learning and linked with a social justice conceptualisation of development.

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Section: Introductionmentioning

confidence: 99%

Can mobile health training meet the challenge of ‘measuring better’?

Winters

Oliver

Langer

2016

Comparative Education

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“…Programs that involve a train-the-trainer component as well as faculty development are essential, although limitations of these models (especially dilution of instruction) must be kept in mind and addressed using other mechanisms such as refresher courses and mentorship or preceptor programs. Additionally, given the increasing familiarity with and use of technology, non-traditional training mechanisms such as the use of messaging applications and other mobile technology-based training tools should be considered, especially as they can be effective mechanisms to extend training beyond face-to-face interactions and/or to continue training during protracted and/or complex emergencies [47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review

Rybarczyk

Ludmer

Broccoli

et al. 2020

Annals of Global Health

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Background: Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher-and lower-resource settings. Objective: To systematically review the literature to evaluate the composition of EM training programs in low-and middle-income countries (LMICs) developed through partnerships. Methods: An electronic search was conducted using four databases for manuscripts on EM training programs-defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care-developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings: Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions: Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.

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“…Therefore, new strategies are required to improve training access for over 1 million health providers across SSA. Any such approach needs to be updated efficiently in real-time as guidelines change in light of new evidence and (ideally) capture data on the number of health workers that are able to train within a certain time period [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is little evidence about the implementation of digital learning interventions that are relevant to the context of low-income settings, that take into account health workers’ initial and continuing clinical training needs, and that adapt learning content in the light of skill mastery and performance as learners continue to develop knowledge [ 9 - 15 ]. In nonclinical, high-resource contexts, adaptive instructional support has been shown to significantly outperform trainer-led large-group instruction, nonadaptive computer-based instruction, and paper-based instruction in producing learning gains [ 4 , 10 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Health care training apps that have been developed to date and the approaches used can broadly be divided into two categories: those that simply replicate existing teaching strategies “on a screen,” for example, by providing questions and answers for exam practice or displaying textbook graphics, that is, the “drill-and-practice” pedagogical approach, and others, that take advantage of features specific to digital devices, examples of which include the ability to respond with different pathways to user choices or the use of animations with which the user can interact, that is, a more learner-centered pedagogical approach [ 9 ]. Serious games, which are games with a specific, applied purpose (other than entertainment) that can be played on mobile phones, are one such way of providing training with the potential to affect health outcomes [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers’ Learning Gain: Randomized Controlled Trial

Tuti¹,

Winters²,

Edgcombe³

et al. 2020

J Med Internet Res

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Background Although smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with gamified approaches remains largely unexplored, despite the lack of traditional training opportunities, and high mortality rates in these settings. Objective The primary aim of this randomized experiment is to determine the effectiveness of offering adaptive versus standard feedback, on the learning gains of clinicians, through the use of a smartphone-based game that assessed their management of a simulated medical emergency. A secondary aim is to examine the effects of learner characteristics and learning spacing with repeated use of the game on the secondary outcome of individualized normalized learning gain. Methods The experiment is aimed at clinicians who provide bedside neonatal care in low-income settings. Data were captured through an Android app installed on the study participants’ personal phones. The intervention, which was based on successful attempts at a learning task, included adaptive feedback provided within the app to the experimental arm, whereas the control arm received standardized feedback. The primary end point was completion of the second learning session. Of the 572 participants enrolled between February 2019 and July 2019, 247 (43.2%) reached the primary end point. The primary outcome was standardized relative change in learning gains between the study arms as measured by the Morris G effect size. The secondary outcomes were the participants individualized normalized learning gains. Results The effect of adaptive feedback on care providers’ learning gain was found to be g=0.09 (95% CI −0.31 to 0.46; P=.47). In exploratory analysis, using normalized learning gains, when subject-treatment interaction and differential time effect was controlled for, this effect increased significantly to 0.644 (95% CI 0.35 to 0.94; P<.001) with immediate repetition, which is a moderate learning effect, but reduced significantly by 0.28 after a week. The overall learning change from the app use in both arms was large and may have obscured a direct effect of feedback. Conclusions There is a considerable learning gain between the first two rounds of learning with both forms of feedback and a small added benefit of adaptive feedback after controlling for learner differences. We suggest that linking the adaptive feedback provided to care providers to how they space their repeat learning session(s) may yield higher learning gains. Future work might explore in more depth the feedback content, in particular whether or not explanatory feedback (why answers were wrong) enhances learning more than reflective feedback (information about what the right answers are). Trial Registration Pan African Clinical Trial Registry (PACTR) 201901783811130; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5836 International Registered Report Identifier (IRRID) RR2-10.2196/13034

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Enhancing emergency care in low-income countries using mobile technology-based training tools

Cited by 22 publications

References 31 publications

Can mobile health training meet the challenge of ‘measuring better’?

Can mobile health training meet the challenge of ‘measuring better’?

Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review

Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers’ Learning Gain: Randomized Controlled Trial

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